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ENGLISH ABSTRACT
胸主动脉腔内修复术后内脏动脉段残余裂口数量与血管重塑的关系
王晓通
陈量
姚勇
作者及单位信息
·
DOI： 10.3760/cma.j.cn112434-20240511-00130
Relationship between the number of residual tears in visceral artery segment and vascular remodeling after endovascular repair of thoracic aorta
Wang Xiaotong
Chen Liang
Yao Yong
Authors Info & Affiliations
Wang Xiaotong
Department of Cardiovascular Surgery, Qianxinan People's Hospital, Xingyi 562400, China
Chen Liang
Department of Cardiovascular Surgery, Qianxinan People's Hospital, Xingyi 562400, China
Yao Yong
Department of Cardiovascular Surgery, Qianxinan People's Hospital, Xingyi 562400, China
·
DOI： 10.3760/cma.j.cn112434-20240511-00130
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摘要

目的探究胸主动脉腔内修复术(TEVAR)后内脏动脉段残余裂口数量与血管重塑的关系。

方法回顾性收集2018年6月至2023年6月于黔西南州人民医院确诊为复杂Stanford B型主动脉夹层(cTBAD)并接受治疗的患者100例为研究对象；根据预后情况，分为良性重塑组(58例)和非良性重塑组(42例)。比较两组患者临床资料、手术前后影像学指标、术后早期形态学特征。通过多因素 logistic分析术后内脏动脉重塑情况的独立影响因素。采用 Cox比例风险回归分析不同疾病分期下内脏动脉段残余裂口数量与非良性重塑的关联分析。应用样条函数与 logistic回归相结合的限制性立方样条法分析内脏动脉段残余裂口数量与非良性重塑的关系。

结果与良性重塑组相比，非良性重塑组患者年龄显著增加、疾病分期显著加重( P<0.05)；术后腹腔干(CAT)、肠系膜上动脉(SMA)、左侧肾动脉(LRA)、右侧肾动脉(RRA)平面真腔直径和面积，LRA平面假腔直径，CAT、SMA平面血栓面积，CAT、SMA、LRA真腔直径显著增加( P<0.05)，CAT、SMA、LRA假腔直径，SMA、LRA血栓直径显著降低( P<0.05)；术后早期假腔最大直径、内脏动脉段残余裂口数量、腰动脉发自假腔数量均显著增加( P<0.05)。进一步多因素 logistic回归分析结果显示，年龄、疾病分期、CAT和SMA的平面真腔面积和平面血栓面积、LRA和RRA的平面真腔面积、内脏动脉段残余裂口数量均是术后内脏动脉重塑情况的独立影响因素。 Cox比例风险回归分析显示不同疾病分期下内脏动脉段残余裂口数量与非良性重塑显著相关，在年龄≤58.7岁和>58.7岁人群中，内脏动脉段残余裂口数量与疾病分期的相乘交互项 P值分别为0.028和0.031。限制性立方样条分析显示无论年龄、疾病分期，内脏动脉段残余裂口数量与非良性重塑关联强度呈非线性剂量－反应关系，内脏动脉段残余裂口数量≥2，非良性重塑风险显著增加。

结论TEVAR后内脏动脉段残余裂口数量与血管重塑显著相关，与非良性重塑关联强度呈非线性剂量－反应关系，内脏动脉段残余裂口数量≥2，非良性重塑风险显著增加。

胸主动脉腔内修复术;内脏动脉段残余裂口数量;血管重塑
ABSTRACT

ObjectiveTo investigate the relationship between the number of residual tears in visceral artery segment and vascular remodeling after thoracic aortic endovascular repair (TEVAR).

MethodsA total of 100 patients diagnosed with complicated Stanford type B aortic dissection (cTBAD) and treated with TEVAR in our hospital from June 2018 to June 2023 were collected retrospectively as study objects, and were divided into benign remodeling group (58 cases) and non-benign remodeling group (42 cases) according to prognosis. The clinical data, imaging indexes before and after operation, and early postoperative morphological characteristics were compared between the two groups. The independent influencing factors of internal artery remodeling after operation were analyzed by multivariate logistic analysis. Cox proportional risk regression was used to analyze the association between the number of residual tears in visceral artery segments and non-benign remodeling at different disease stages. The relationship between the number of residual tears and non-benign remodeling of visceral artery segments was analyzed by the restricted cubic spline method combined with spline function and logistic regression.

ResultsCompared with the benign remodeling group, the age and disease stage of the non-benign remodeling group were significantly increased ( P<0.05). After operation, the diameter and area of celiac trunk (CAT), superior mesenteric artery (SMA), left renal artery (LRA) and right renal artery (RRA) were significantly increased ( P<0.05), while the diameter and area of CAT, SMA and LRA were significantly decreased ( P<0.05). The maximum diameter of the lumen, the number of residual lacerations in the visceral artery segment and the number of lumen originating from the lumbar artery were significantly increased ( P<0.05). Further logistic regression analysis showed that age, disease stage, plane true lumen area and plane thrombus area of CAT and SMA, plane true lumen area of LRA and RRA, and number of residual tears of visceral artery segment were independent factors influencing the remodeling of internal arteries after surgery. Cox proportional risk regression analysis showed that the number of residual visceral artery segments was significantly correlated with non-benign remodeling under different disease stages. The multiplicative interaction terms of the number of residual visceral artery segments and disease stages were 0.028 and 0.031 in people aged ≤58.7 years old and>58.7 years old, respectively. Restricted cubic spline analysis showed that regardless of age and disease stage, there was a nonlinear dose-response relationship between the number of residual tears in visceral artery segment and the intensity of non-benign remodeling association, and the number of residual tears in visceral artery segment ≥2 significantly increased the risk of non-benign remodeling.

ConclusionThe number of residual tears in visceral artery segment was significantly correlated with vascular remodeling after TEVAR, and the correlation strength with non-benign remodeling showed a nonlinear dose-response relationship. When the number of residual tears in visceral artery segment was ≥2, the risk of non-benign remodeling was significantly increased.

Thoracic endovascular aortic repair;Number of residual tears in the visceral artery segment;Vascular remodeling
Yao Yong Email: mocdef.qabq4370691202
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引用本文

王晓通,陈量,姚勇. 胸主动脉腔内修复术后内脏动脉段残余裂口数量与血管重塑的关系[J]. 中华胸心血管外科杂志,2025,41(03)：168-176.

DOI:10.3760/cma.j.cn112434-20240511-00130

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主动脉夹层(aortic dissection，AD)是人体心血管系统的一种危急重症，常导致灾难性后果，自然预后差，未经及时治疗的患者2周内病死率高达80% [ 1 , 2 ]。1970年Daily根据夹层累及范围提出Stanford分型，将AD分为A型和B型 [ 3 ]。临床上根据发病时间将Stanford B型AD(Stanford type B aortic dissection，TBAD)分为超急性期(≤24 h)、急性期(≤14天)、亚急性期(15～90天)及慢性期(>90天) [ 4 , 5 ]，急性TBAD如果用药后仍疼痛、血压无法控制、器官灌注不佳，或出现动脉破裂征象，则为复杂型TBAD(complicated Stanford type B aortic dissection，cTBAD)，否则为非复杂型TBAD(uncomplicated Stanford type B aortic dissection，uTBAD) [ 6 , 7 ]。其中对于cTBAD而言，目前国际上较为认可的治疗方式是尽早行胸主动脉腔内修复术(thoracic endovascular aortic repair，TEVAR)，原理为通过覆膜支架封堵第一主裂口，阻断经胸主动脉段撕裂口进入假腔的血流，促进夹层假腔血栓形成且辅助真腔的重塑，对其他部位的裂口(如腹主动脉段、髂动脉段裂口等)通常旷置不进行干预而将其统称为残余裂口 [ 8 , 9 ]。但在TEVAR治疗中，有一部分患者出现主动脉扩张、假腔不闭合等血管不良重构，从而引起长期的主动脉相关不良事件，血管重塑受到干预时机、支架移植物长度、残余裂口、术后内漏等多方面因素影响，在TEVAR术后，早期发现并控制可能预示血管重塑不良的相关因素及其必要。因此，本研究以100例cTBAD患者为研究对象，探究TEVAR后内脏动脉段残余裂口数量与血管重塑的关系，以期为探讨腔内技术对血管形态学的影响，并对其进行有效干预，以减少再手术和术后死亡，提高术后生存率提供参考。
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备注信息
A
姚勇　Email: mocdef.qabq4370691202
B

王晓通：酝酿和设计实验、实施研究、采集数据、分析/解释数据、起草文章、对文章的知识性内容作批评性审阅；陈量：采集数据、分析/解释数据、统计分析；姚勇：对文章的知识性内容作批评性审阅、行政、技术或材料支持、指导、支持性贡献

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